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Dr. Stevens
Dr. Stevens, Ophthalmologist
Category: Eye
Satisfied Customers: 1404
Experience:  Board Certified Ophthalmologist
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My sister had successful cataract surgery several years ago.

Customer Question

My sister had successful cataract surgery several years ago. However, during the procedure she was moving because of insufficient anesthesia. The lens has now slipped because of 'loose zonules'. What are the remedies for this? If a surgical procedure, which is most effective? Why does this happen? Could it have been the result of her movements during the initial surgery.
Submitted: 7 years ago.
Category: Eye
Expert:  Dr. Stevens replied 7 years ago.

Hello there

patient movement is a huge factor for surgical complications as the one you described. But sometimes this happens even in the most steady patient. The operative report typically describes what event led to the complications that occurred as loose zonules are typically noticed in the surgery. WIth that said, the way to fix this depends on how much movement the lens implant has done. Typically, the implants are around 6mm from side to side and the typical pupil size is 3-6 mm depending on lighting conditions. If the lens has moved so much as to give her double vision all the time, the fix will need to be surgical. That would be in a setting just like the cataract surgery and often we can reposition the lens. Sometimes the lens has to be removed and replaced and this is not the easiest task. If the lens has moved a small amount to where double vision is in certain instances such as low lighting, then even keeping the pupil artificially small with an eye drop called pilocarpine can work. On the 3rd extreme where the lens has flat out fallen out of the pupil axis, and vision is always blurry and there is no diuble vision, you can simply use a contact lens on that eye daily to restore the vision. Most of the patients who have loose zonules fall into scenario 1, some into scenario 2 and rarely into scenario 3 as i described above. I think I covered all the questions you had, if you have any more, let me know, Regards XXXXX

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Customer: replied 7 years ago.
Hi... thank you for this. I much appreciate. The manifestation she is now experiencing is loss of peripheral vision. She has had a prior procedure of a detached retina. Could this be a factor?
Expert:  Dr. Stevens replied 7 years ago.


the thing about a detached retina is it will lead to some loss of peripheral vision. A couple of important things to she losing peripheral vision in the same manner she experienced when she had her retina detached ?? or is she experiencing loss of vision in the periphery all around? how is the vision in this eye (do you have acuity) and does she see double at all? lastly, some people get glaucoma too from surgical complications, has she been evaluated for this ? I will be out for a few hours and will respond to this a bit later...Regards

Customer: replied 7 years ago.
sorry for the delay... my sister is in California and I'm in NJ... so coordination not always instantaneous :-)
She's a member of Kaiser... they did her procedure.

She only rarely has double vision. Problem is diminished peripheral vision. Her field of vision is not always clear. She must work to focus it, but can do. Generally, there is a lack of clarity.

Thanks again.... have a good weekend!
Expert:  Dr. Stevens replied 7 years ago.

Hello there

When there is zonular dehiscense and complicated surgery, several things can cause her symptoms. Sometimes the capsular bag can also cloud up severely and cause blurring of vision. Typically unless the retina detaches again, the visual field loss from the original detachment should not increase. My suspicision putting all this together is that she has a dislocated lens and lots of capsular clouding which is causing her vision. I suspect the best surgical approach if she decides to proceed with it would be to either remove the lens she has and put in a new one. This would be done if the one she has is difficult to reposition as it is often the case. I wish her well, please let me know if you or she has more concerns, Regards XXXXX XXXXX

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